Doctors frame guidelines for best cancer treatment

More than half of Singapore's cancer doctors have come together to produce the country's first guidelines on best practices for the treatment of several types of cancer.
More than half of Singapore's cancer doctors have come together to produce the country's first guidelines on best practices for the treatment of several types of cancer. PHOTO: ST FILE

More than 70 S'pore cancer experts come up with best practices tailored for patients here

The condition may be the same, but the best treatment for a Singaporean cancer patient may not be the same as, say, that for a patient from Europe.

That is why more than half of Singapore's cancer doctors have come together to produce the country's first guidelines on best practices for the treatment of several types of cancer.

They hope this will provide an easy reference for doctors, patients and policymakers on what works best for local patients.

  • No funding from drug firms

  • It is important to note that the Singapore Cancer Network guidelines received no funding from any pharmaceutical companies.

    This is because funding from a company that produces cancer drugs - even if the money given comes with no strings attached - will always be suspect as he who pays the piper calls the tune.

    The only funding for the project was from the Academy of Medicine and the Singapore Society of Oncology, both neutral parties.

    This being the case, it should be "safe" to take the guidelines as the objective professional recommendations from experts in the field.

Dr Tan Min Han, lead editor for the 15 sets of guidelines, said these do not always mirror recommendations in the United States or Europe.

This is because drugs sometimes work differently on different ethnic groups, said Dr Tan, a principal investigator at the Institute of Bioengineering and Nanotechnology and a visiting consultant at the National Cancer Centre Singapore.

For example, standard first-line treatment options for some types of lung cancer in Singapore have differed from those in the US for many years. Also, some chemotherapy drugs are commonly prescribed at lower doses in Singapore compared to countries in the West, as the effects of these drugs are not the same on Asians and Caucasians.

The guidelines are tailored to what best suits the local population. These come under the Annals, the publication of the Academy of Medicine, Singapore. Work on them started two years ago.

There was no funding from any pharmaceutical company.

More than 70 of Singapore's 108 cancer doctors contributed to the guidelines on the treatment for nearly all solid cancer tumours, such as for breast, colon and lung.

Almost all oncologists with sub-specialities - the experts among experts - were involved.

Dr Tan said there are plans to provide annual updates, as new cancer treatments are being developed all the time.

However, he stressed that the guidelines are just that, and not the final word on cancer treatment.

He said: "Clinical judgment remains paramount in patient management. There are certainly times when it would be medically inappropriate to follow guidelines."

This includes cases when patients suffer from several medical conditions.

The guidelines also took into account the cost of treatment, which can be very high for some of the newer drugs.

Dr Tan said in his editorial in the Annals: "Oncology drug costs are a real dimension to patient care.

"It would be remiss to divorce treatment costs, also known as financial toxicity, from real-world practice and individualised patient counselling."

Dr Chan Ching Wan, a senior breast surgeon from the National University Cancer Institute, said the guidelines serve as signposts, outlining the principles for management.

Her colleague, Professor Chng Wee Joo, who heads haematology, said that as the guidelines are based on "expert consensus adapted to the Singapore situation and formulated by local experts, they should act as a good framework for local practising oncologists".

Associate Professor Lim Soon Thye, who heads medical oncology at the National Cancer Centre Singapore, said the guidelines "make it easier to estimate the cost of care more accurately" and can "reduce variations in treatment and improve quality".

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A version of this article appeared in the print edition of The Straits Times on March 01, 2016, with the headline 'Docs frame guidelines for best cancer treatment'. Print Edition | Subscribe